Document Detail

The crossover sign overestimates acetabular retroversion.
MedLine Citation:
PMID:  23136058     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The crossover sign is a radiographic finding associated with cranial acetabular retroversion and has been associated with pincer-type femoroacetabular impingement (FAI) in patients with hip pain. Variable morphology, location, and size of the anterior inferior iliac spine (AIIS) may contribute to the crossover sign even in the absence of retroversion. Thus, the sign may overestimate the incidence of acetabular retroversion.
QUESTIONS/PURPOSES: We asked: Can the crossover sign appear on standardized, well-positioned AP pelvis radiographs despite the absence of acetabular retroversion? And what is the contribution of variable size and morphology of the AIIS to a crossover sign?
METHODS: We evaluated radiographs of 53 patients with symptomatic FAI in the absence of substantial chondral degenerative changes (< Tönnis Grade 2). Forty-one radiographs met the appropriate criteria of neutral tilt and obliquity. Three independent reviewers determined presence and location of the crossover sign. Acetabular version was defined using high-resolution three-dimensional CT. CT reconstructions were used to define three AIIS types addressing AIIS morphology.
RESULTS: Nineteen of 38 radiographs with a crossover sign on AP radiographs had focal or global acetabular retroversion on three-dimensional CT (positive and negative predictive values = 50%). In contrast, the AIIS extended to or below the level of the anterior superior acetabular rim and was partially or completely responsible for the appearance of a radiographic crossover sign in all 19 hips with an anteverted acetabulum. High interobserver reliability (kappa > 0.8) was found for AIIS types.
CONCLUSIONS: A crossover sign is frequently present on well-positioned AP pelvis radiographs in the absence of acetabular retroversion. Variable AIIS morphology may explain the appearance of this sign in the presence or absence of acetabular retroversion.
Ira Zaltz; Bryan T Kelly; Iftach Hetsroni; Asheesh Bedi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-09     Completed Date:  2013-09-26     Revised Date:  2014-08-05    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2463-70     Citation Subset:  AIM; IM    
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MeSH Terms
Acetabulum / radiography*
Bone Retroversion / classification,  epidemiology,  radiography*
Femoracetabular Impingement / epidemiology,  radiography*
Hip Joint / radiography*
Imaging, Three-Dimensional
Observer Variation
Predictive Value of Tests
Radiographic Image Interpretation, Computer-Assisted
Reproducibility of Results
Tomography, X-Ray Computed*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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